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Year 2 - Renal > Pathology + clinical of UTI > Flashcards

Pathology + clinical of UTI Flashcards

1
Q

Classic symptoms (4) /signs (2) of a lower UTI

A

Dysuria (pain on peeing)
Polyuria
Frequency (means increased frequency)
Urgency

Haematuria
Suprapubic tenderness

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2
Q

All of urinary tract is sterile apart from the

A

terminal urethra

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3
Q

Terminal urethra is not sterile compared to rest of urinary tract as it’s covered in what

A

skin and gut flora

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4
Q

When collecting urine specimen for culture, why is mid stream urine collected instead of initial urine

A

because initial void of urine gets heavily contaminated with flora as it exits the terminal urethra

Mid stream urine will contain less flora; will still be present as flora is always present but diminished

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5
Q

In an MSSU (mid stream specimen urine) culture, a bacterial growth of 10^5 per ml indicates

A

infection

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6
Q

In an MSSU (mid stream specimen urine) culture, a bacterial growth of <10^3 per ml indicates

A

no infection

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7
Q

UTIs include the following, define each:

Cystitis
Bacteriuria
Pyuria
Sterile pyuria
Acute pyelonephritis
Chronic pyelonephritis
A

Cystitis - inflammation of bladder

Bacteriuria - bacteria in urine

Pyuria - large amount of pus cells in urine

Sterile pyuria - urine is negative on culture but significant numbers of pus cells are present

Acute pyelonephritis - kidney infection

Chronic pyelonephritis - renal scarring and potentially loss of renal function due to recurrent acute pyelonephritis

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8
Q

How may UTI present in infants (3)

A

Fever
Malaise
Failure to thrive/poor feeding

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9
Q

How many UTI present in the very old (2)

A

Incontinence

Immobile

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10
Q

How should women presenting with 3 or more of the classic UTI symptoms (Dysuria, Polyuria, Frequency,
Urgency) or with particularly severe symptoms, be treated

A

should be treated empirically with antibiotics without further investigation.
-3 day course

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11
Q

On dipstick testing, the presence of the following 4 things usually indicates UTI:

A

Nitrite
Protein
Leukocytes
Blood

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12
Q

Causative organisms of UTI in community and hospital (6)

A

More in community:
E. coli
Staph. saprophyticus

More in hospital:
Proteus sp. 
Enterococcus faecalis 
Klebsiella sp. 
Pseudomonas sp.
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13
Q

Most common UTI causative organism

A

E. coli

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14
Q

Women presenting with 3 of the classic UTI symptoms or more severe are just treated empirically with antibiotics without investigation, however women presenting with 2 classic symptoms or less are managed differently; how?

A

MSSU

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15
Q

Predisposing factors of UTI (6)

A

Stasis of urine, e.g. in pregnancy
Anatomical abnormality of UT, e.g. duplicated ureter, vesico-ureteric reflux
Renal cysts
Calculi in the urinary tract
Immunosuppression, e.g. long term steroids, DM
Foreign body, e.g. catheter

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16
Q

Stasis of urine is a predisposing factor to a UTI, what are some causes of stasis of urine (2)

A

Obstruction of the UT

Spinal cord/brain injury - causes loss of feeling of a full bladder

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17
Q

Immunosuppression predisposes to UTIs - what kind of people does this include

A

Diabetics
On chemo
Long term corticosteroids

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18
Q

Describe how an obstruction at the level of the urethra can cause kidney swelling

A

Urine backflow –> urethral and bladder dilation –> bilateral ureter dilation –> bilateral hydronephrosis (swelling of kidneys due to build up of urine)

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19
Q

Describe how obstruction at the level of the renal pelvis can cause hydronephrosis

A

Unilateral dilation of ureter –> unilateral hydronephrosis

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20
Q

Describe 2 ways an obstruction in the urinary tract can predispose to UTI

A

Slows urine flow so can’t flush bacteria out –> infection

Slows urine flow –> sediments form –> calculi formation –> obstruction –> more dilation and infection

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21
Q

What is the triad of the consequences of obstruction in the urinary tract

A

Obstruction –> infection –> calculi –> obstruction again –> more infection etc

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22
Q

Name some congenital urinary tract abnormalities/obstructions

A

Vesicle-ureteric (bladder-ureter) reflux

Congenital pelvi-ureteric junction obstruction

23
Q

What is vesico-ureteric reflux

A

Congenital problem where urine back flows from bladder into kidneys because the normal constriction of the ureter as it enters the bladder wall is lost, allowing urine to reflux

24
Q

Common causes of urinary tract obstruction

  • men
  • women
  • both
A

Benign prostatic hyperplasia (BPH)

Uterine prolapse

Tumours

25
Q

How does a spinal cord/brain injury cause stasis of urine

A

Decreased sensation of when to micturate as can’t sense when bladder is full

When eventually micturating, not emptied completely so high residual volume of urine in bladder –> stasis of urine

26
Q

Predisposing factors to UTI specific to females (5)

A

Short urethra
Closeness of urethra to rectum
Lack of bacteriostatic prostatic secretion
Sexual activity
Pregnancy - pressure on ureters and bladder

27
Q

60 year old women who presents with UTI symptoms who hasn’t had something like this since 25 - what would you be suspicious of

A

uterine prolapse

28
Q

Acute complication of UTI

A

Sepsis

29
Q

Chronic complications of UTI

A

Chronic pyelonephritis –> hypertension, renal failure

30
Q

The following are features of acute urinary retention except:

a. painful
b. palpable bladder
c. inability to urinate
d. bladder volume >800ml
e. percussible bladder

A

d

31
Q

The following organisms are commonly associated with urinary tract infections except:

a. E. coli
b. Klebsiella species
c. Proteus species
d. Chlamydia trachomatis
e. Pseudomonas aeruginosa

A

d

32
Q

Clinical features of acute pyelonephritis (6)

A

Fever
Flank pain/ costovertebral angle tenderness
Nausea/vomiting

Dysuria/frequency - LESS

33
Q

Clinical features of UTI in children

A 
Fever
Irritability
Poor feeding
Dysuria
Frequency
Abdo/flank pain
34
Q

1st line investigation of UTI + other investigations

A

Urine dipstick - for blood, nitrites, proteins, leukocytes
Urine microscopy
Urine culture + sensitivity

35
Q

Imaging investigations of UTI in children/men/recurrent UTIs (not for uncomplicated UTIs in women) (2)

A

USS

CT of renal tract

36
Q

In uncomplicated UTIs, urine dipstick is usually enough evidence to give antibiotics empirically but what LAB investigations should be done in complicated UTIs to confirm diagnosis (2)

A

Urine CULTURE + sensitivity - to see what antibiotics to use

Urine microscopy

37
Q

Treatment of uncomplicated UTI in females

A

Empirical - 3 days of trimethoprim or nitrofurantoin

38
Q

Which antibiotic that treats uncomplicated UTIs in females is not recommended in pregnant females

A

Trimethoprim

39
Q

Which UTI causative organisms are more often found in hospital patients, often associated with catheters or instrumentation of the urinary tract (3)

They tend to be more antibiotic resistant

A

Proteus, Klebsiella and Pseudomonas sp

40
Q

Treatment of complicated UTI in females

  • outpatient (2)
  • inpatient (if severe) (1)
A

Outpatient

  • 7 days ciprofloxacin
  • Nitrofurantoin if pregnant

Inpatient
-If severe, may need IV gentamicin or ceftriaxone

41
Q

Treatment of acute pyelonephritis

-empirical (2 options)

A

Antibiotic chosen should be based on culture sensitivity results

Empirical antibiotics include:

  • ciprofloxacin (a fluoroquinolone)
  • or cefixime (a cephalosporin)
42
Q

Describe the various tests which may be performed on urine and explain the significance of the results in relation to infection (3)

A

Urine dipstick - likely infection if there’s proteins, blood, nitrites, leukocytes

Urine microscopy - can do gram stain which will stain the bacteria (typically gram -ve rods, e.g. E. coli)

Urine culture + sensitivity - culture may show lots of bacteria colony forming units

43
Q

What is pyelonephritis + pathophysiology of acute pyelonephritis

A

Infectious inflammatory disease of the renal parenchyma, calices, and pelvis

Usually due to gut bacteria that ascend up the urinary tract to kidneys or spread via blood to kidneys

44
Q

Investigations of acute pyelonephritis (6)

-bloods

A 
Urinalysis - dipstick, 
Urine microscopy + gram stain
Urine culture + sensitivity
FBC - shows leukocytes
CRP
Blood culture
45
Q

Preferred antibiotic of use for UTIs in pregnancy

A

Nitrofurantoin

46
Q

Catheter related UTI shouldn’t automatically be treated because catheters become colonised with mixed organisms and a positive culture is not an indication for treatment

But what would indicate treatment for these patients

A

symptomatic (e.g. feverish, suprapubic pain)

and/or shows signs of infection (e.g. pyrexial, tachycardic, pyuria in urine specimen)

47
Q

Patients suffering from recurrent episodes
of UTI require careful history taking and examination to establish whether there are any risk factors which can be reversed.

General management principles for these patients with recurrent UTIs (4)

A

Drinking lots of fluids (≥1.5L/day),

Emptying the bladder after sexual intercourse

Void every 2-3 hours

Long term antibiotic prophylaxis, with one tablet of nitrofurantoin or trimethoprim per night for up to one year, may be successful if no predisposing factors found

48
Q

What is asymptomatic bacteruria

A

Presence of bacteria (>10^5 colony forming units/ml urine) in urine but no symptoms/signs

49
Q

UTI in children should be followed up to identify if they have what

A

Vesicle-ureteric reflux as this can lead to renal scarring if untreated

50
Q

Methods of urine collection (3)

+ methods of transportation to the lab (2)

A
  • MSSU
  • Catheter specimen if catheterised - from the port, NOT the collection bag
  • Clean catch urine - in children

Collected into a sterile vessel that is kept refrigerated
OR
Collected into a special container containing boric acid to prevent bacterial overgrowth

51
Q

What is reflux nephropathy

A

Damage/eventual scarring of the kidneys due to back flow of urine, usually due to vesico-ureteric reflux

52
Q

Most common cause of chronic pyelonephritis

+ may or may not lead to

A

Chronic vesico-ureteric reflux

End stage renal disease

53
Q

Patients with chronic pyelonophritis may have a history of (3)

A

Vesicoureteric reflux
Acute pyelonephritis
Urinary tract obstruction, e.g. congenital/anatomical abnormalities, BPH, calculi

54
Q

Sterile pyuria and negative urine cultures suggest urinary tract infection by the bacteria … or …

A

Neisseria gonorrhoeae or Chlamydia trachomatis.

Year 2 - Renal (21 decks)

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